Provider Demographics
NPI:1194742999
Name:SALARY-MITCHELL, TISHA LAVETA (MD)
Entity type:Individual
Prefix:DR
First Name:TISHA
Middle Name:LAVETA
Last Name:SALARY-MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TISHA
Other - Middle Name:LAVETA
Other - Last Name:SALARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11370 ANDERSON ST
Mailing Address - Street 2:SUITE 3615
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3450
Mailing Address - Country:US
Mailing Address - Phone:909-558-2481
Mailing Address - Fax:909-558-2608
Practice Address - Street 1:41865 BOARDWALK
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9026
Practice Address - Country:US
Practice Address - Phone:760-341-5570
Practice Address - Fax:760-341-5622
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine